Department of Vascular Surgery, Cheltenham General Hospital, Cheltenham, UK.
Br J Surg. 2010 Oct;97(10):1497-502. doi: 10.1002/bjs.7137.
Incisional herniation is a common complication of abdominal aortic aneurysm (AAA) repair. This study investigated whether prophylactic mesh placement could reduce the rate of postoperative incisional hernia after open repair of AAA.
This randomized clinical trial was undertaken in three hospitals. Patients undergoing elective open AAA repair were randomized to routine abdominal mass closure after AAA repair or to prophylactic placement of polypropylene mesh in the preperitoneal plane.
Eighty-five patients with a mean age of 73 (range 59-89) years were recruited, 77 (91 per cent) of whom were men. There were five perioperative deaths (6 per cent), two in the control group and three in the mesh group (P = 0.663), none related to the mesh. Sixteen patients in the control group and five in the mesh group developed a postoperative incisional hernia (hazard ratio 4.10, 95 per cent confidence interval 1.72 to 9.82; P = 0.002). Hernias developed between 170 and 585 days after surgery in the control group, and between 336 and 1122 days in the mesh group. Four patients in the control group and one in the mesh group underwent incisional hernia repair (P = 0.375). No mesh became infected, but one was subsequently removed owing to seroma formation during laparotomy for small bowel obstruction.
Mesh placement significantly reduced the rate of postoperative incisional hernia after open AAA repair without increasing the rate of complications.
切口疝是腹主动脉瘤（AAA）修复术后的常见并发症。本研究旨在探讨预防性放置补片是否可以降低开放修复 AAA 术后切口疝的发生率。
本随机临床试验在三家医院进行。择期行开放 AAA 修复的患者被随机分为 AAA 修复后常规腹部肿块闭合组或预防性放置聚丙烯补片于腹膜前间隙组。
共纳入 85 例患者，平均年龄 73 岁（59-89 岁），其中 77 例（91%）为男性。围手术期死亡 5 例（6%），对照组 2 例，补片组 3 例（P=0.663），均与补片无关。对照组 16 例和补片组 5 例发生术后切口疝（风险比 4.10，95%置信区间 1.72 至 9.82；P=0.002）。对照组切口疝发生在术后 170-585 天，补片组发生在术后 336-1122 天。对照组 4 例和补片组 1 例行切口疝修补术（P=0.375）。无补片感染，但 1 例因粘连性肠梗阻剖腹探查时出现血清肿而被取出。
开放 AAA 修复后预防性放置补片可显著降低术后切口疝的发生率，且不增加并发症发生率。
